CH52_Assisting_with_Phlebotomy_Quiz1

MA 112, venipuncture, blood draw, Beal, Kinns Medical Assistant, medical assisting, Quiz 1, Chapter 52
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Terms in this set (...)

anticoagulant-Define?
substances that prevent blood from clotting (coagulating) by either of 2 methods.
anticoagulant- 2 methods?
1. chelating/binding or precipitating calcium so it is unavailable for process OR 2. inhibiting the formation of thrombin(enzyme) needed to convert fibrinogen to fibrin for process
must mix tube immediately when filled (inversions)
4 types of anticoagulants are?
EDTA/ethylenediaminetetra acetic acid
citrates
heparin
oxalates
EDTA/ethylenediaminetetra acetic acid
commonly available in sodium or potassium based salt
binds/chelates calcium preventing coagulation
lavender-top tube, some royal blue tubes, pearl tubes
citrates
binds/chelates calcium preventing coagulation
light-blue top
calcium added back in to centrifuged plasma specimen to time coagulation
heparin
3 types: ammonium, lithium, sodium heparin
inhibits the thrombin formation preventing coagulation
green-top tube, some royal blue tubes
LH causes least test interference except for lithium level tests; SH can't be used for electrolyte tests
oxalate
a salt or ester of oxalic acid, no info from lecture
HBV, HIV, AIDS
Bloodborne virus
Hepatitus B Virus, immunization available
Human Immunodeficiency Virus no immunization available, develops into AutoImmune Deficiency Syndrome
SST
Serum separator tube RED STOPPER non-additive tube
also red/gray stopper with gold hemogard cover
serum is the fluid portion of the blood that remains AFTER clotting, yellowish in color
cc
cubic centimeter/mL
1/1000 of a liter
most syringes/ blood draw tubes are labeled in either ccs or mLs
also means Chief Complaint
Evacuated tube system
beginning with tube, stopper, flange end of needle holder, sheathed needle portion of multisample needle extends into needle holder, hub containing shaft of needle ending with needle point
needle gauge
diameter of hole going up through the needle (lumen), the larger the gauge number the narrower the diameter of the hole,
gauge # marked on the hub and outside of disposable packet
venipuncture usual site and veins?
antecubital area (ac)
median cubital, cephalic, basilic veins are there
median cubital first choice
basilica and median basilica would be last choice because they are near the brachial nerve and artery which could be punctured accidentally; if no suitable ac site check back of hand or wrist
sites that should not be used for venipuncture?
Avoid veins that feels hard or cord-like or appear damaged; burned, damaged, infected, swollen, wounded areas; areas with skin conditions if possible, side of body where a stroke affected or mastectomy was performed; or near an iv.
Technique to stop veins from rolling?
anchoring the vein: free hand grasping Pt's arm supporting the back of arm just below elbow. Place thumb a minimum of 1-2 inches below and slightly to the side of the intended venipuncture site and pull skin toward the wrist. This is the "L" hold technique for anchoring a vein.
what causes hemolysis?
RUPTURE OF RED BLOOD CELLS RELEASING HEMOGLOBIN
alcohol preparation: transfer of alcohol into the specimen causes hemolysis; allow venipuncture site to dry completely
If sudden swelling occurs at venipuncture site, what do you do?
probably a hematoma, caused by blood leaking into surrounding tissues. Discontinue procedure stat, loosen tourniquet, remove needle, apply pressure for a minimum of 3 minutes, then apply ice pack to area, notify physician, observe area to make sure bleeding stops, complete an incident report to go in patient chart.
If patient becomes dizzy during venipuncture, what is your first priority?
THE PATIENT'S SAFETY, get the tourniquet off and needle out as quickly as possible, guide the patient to floor gently if they are beyond sitting, do not leave your patient alone!
Book says: For syncope: position Pt's head between knees if sitting, check and record pulse, B/P and rpm and continue to observe Pt. do not leave pt. unattended. For nausea: place cold cloth on Pt forehead, give basin in case of vomiting, instruct to take deep breaths, alert physician
What might happen if needle is removed before tourniquet?
blood may run down the arm and alarm the patient
What is the OSHA standard regarding needle disposal?
needle and tube holder must be promptly discarded in a Sharps container as a single unit; a syringe safety needle may be removed and discarded so the syringe can be used with the transfer device, when the transfer is complete, the syringe and transfer device will be discarded as one unit still into the Sharps container
Why would you use a syringe method vs. evacuated tube method?
Because the syringe can be manually controlled reducing the pressure of the draw. The evacuated tubes may have too much suction for fragile veins and would collapse them. This could often be the case in geriatric patients. But other patients may also be at risk. Also small children.
what causes hemolysis?
RUPTURE OF RED BLOOD CELLS RELEASING HEMOGLOBIN
incorrect needle size: A high-G needle will cause the bloood to be forced through a small lumen with gret force shearing cell membranes, a lowG needle will allow a large amount of blood in quickly causing frothing Choose the correct needle for the job, a 19-23 gauge needle
what causes hemolysis?
RUPTURE OF RED BLOOD CELLS RELEASING HEMOGLOBIN
loose connections on the vaccuum tube assembly: if the connection between the needle holder and the double-pointed needle or the syringe and needle is loose, air can enter the sample and cause frothing, ensure that all connections are tight before beginning the venipuncture
what causes hemolysis?
RUPTURE OF RED BLOOD CELLS RELEASING HEMOGLOBIN
removing the needle from the vin with the tube intact: remaining vaccuum in the tube can cause air to be drawn forcefully into the tube, causing frothing, remove the final tube from the needle holder before withdrawing the needle from the patient's vein
what causes hemolysis?
RUPTURE OF RED BLOOD CELLS RELEASING HEMOGLOBIN
underfilled tubes: underfilling tubes leads to an improper blood/additive ratio, certain additives, such as sodium flouride, in disproportionate amounts can cause hemolysis, permit blood to flow into the tubes until no more movement can be seen
what causes hemolysis?
RUPTURE OF RED BLOOD CELLS RELEASING HEMOGLOBIN
Syringe collections:pulling back forcibly on the plunger draws blood too quickly through the needle shearing cell membranes, transferring blood into a vaccuum tube further traumatizes red blood cells, pump plunger several times before use to loosen it w/in the barrell. Pace the aspiration rate so that there is no more than 1 mL of air space at any time. Transfer blood into vaccuum tube immediately, preferably using a transfer device.
what causes hemolysis?
RUPTURE OF RED BLOOD CELLS RELEASING HEMOGLOBIN
Mixing tubes too vigorously:all tubes except the red -stoppered tube must be mixed. Anything other than gentle inversion can hemolyze cells, gently invert tubes immediately after the draw
what causes hemolysis?
RUPTURE OF RED BLOOD CELLS RELEASING HEMOGLOBIN
Temperature and transport problems: trauma and temperature extremes can damage cells, freezing will cause ice crystals that puncture cell membranes,tubes should be transported in the upright position with as little trauma as possible, temperature should be controlled, not too hot or cold
what causes hemolysis?
RUPTURE OF RED BLOOD CELLS RELEASING HEMOGLOBIN
Separation of plasma or serum from red cells: removing the serum or plasma from the cells minimizes the risk of contaminating the specimen with red cell contents, blood samples should be centrifuged when applicable, as soon as possible, and serum or plasma removed from the cells
what causes hemolysis?
RUPTURE OF RED BLOOD CELLS RELEASING HEMOGLOBIN
prolonged tourniquet time: the tourniquet restricts blood flow, interstitial fluid can leak into veins hemolyzing red cells, adhere to the 1-minute rule for T application
what causes hemolysis?
RUPTURE OF RED BLOOD CELLS RELEASING HEMOGLOBIN
Poor collection (blood flowing too slowly into the tube): the lumen of the needle may be blocked because it is too close to the inner wall of the vein, withdraw the needle slightly to center it in the vein
Order of Draw
sterile tube (Yellow), citrate (light blue), SST (red) or (red/grey with gold hemogard top), heparin (green) or (grey/blk with grey hemogard top), EDTA (lavender) or (pearl), Flouride (grey) From Handout
Order of Draw
1. sterile tube/blood culture
2. blue top coagulation tube
3. serum tube with or without clot activator, with or without gel
4. heparin tube with or without gel plasma separator
5. EDTA tube
6. Glycolytic inhibitor tube
(from lecture .PPT)
Order of Draw (mnemonic)
Stop-Light-Red-Stay-Put
Green-Light-Go
Sterile, Light blue stopper, Red stopper, SST, PST
Green stopper, Lavender stopper, Gray stopper
Veins in forearm
On diagram we were given:
Cephalic on thumb side of arm: Just cepahilic nearest elbow, median cephalic branch coming to point in "m", supplementary cephalic as cephalic continues toward wrist. Heel of hand side: Basilic closest to elbow, median basilic branch to point in "m",
Near wrist: median antebrachial fairly central of 3 veins but slightly closer toward edge of arm by heel of hand
antiseptic
an agent that inhibits bacterial growth that can be used on human tissue
bifurcation
the point of forking or separating into two branches
hematocrit
the percentage by volume of packed red blood cells on a given sample after centrifugation
hemoconcentration
a situation in which the concentration of blood cells is increased in proportion to the plasma
hemolysis
the destruction or dissolution of red blood cells with subsequent release of hemoglobin
plasma
the liquid portion of whole blood that contains active clotting agents
serum
the liquid portion of whole blood that remains after the blood has clotted
stat
with no delay, at once
syncope
fainting
thixotropic gel
a material that appears to be a solid until subjected to a disturbance, such as centrifugation, upon which it becomes a liquid
Equipment needed for routine venipuncture
double-pointed safety needles;
evacuated, stoppered tubes;
needle holder;
sharps container
syringes;
winged infusion sets (butterfly needles);
tourniquet;
marking pen;
alcohol swabs;
gauze pads;
bandages;
gloves;
CLSI
Clinical and Laboratory Standards Institute
we follow their rules for venipuncture
HCW
health care worker
OSHA wants everyone to use SESIP
a "sharp with engineered sharps injury protection"
examples:
self-sheathing safety devices,
retractable safety device,
needle-blunting safety device,
hinged or sliding safety mechanisms
ASCP, NCA
International Academy of Phlebotomy Sciences
National Certification Agency